On February 25, 2011, Northwest Dentistry sat down with MDA president Timothy J. Flor to talk about his year so far. An MDA stalwart with a long record of service to patients and colleagues alike, Dr. Flor brought a philosophy of decision making based on understanding, attentiveness to all that surrounded him, and an immovable commitment to finding a way to bring good outcomes out of difficult situations. With an energy level rivaling that of an extreme sports enthusiast, he still has the patience to make sure each and all who wish to be included in the work have that opportunity. And this is a man who knows what the phrase “strong dental family” can mean. The Editors
NWD: As is our tradition, let’s begin with some personal background: where you grew up, what your family was like, your education, and why you decided on dentistry as a career.
Dr. Flor: I grew up with three brothers and three sisters in a small town, New Richland, in southern Minnesota — 1,000 then, 1,100 now. My education there was in a small but strong public school, and it was excellent. We graduated six or seven dentists in three or four years, two or three physicians, several lawyers and engineers — just amazing. My father, who was a dentist, as are two of my brothers, chaired the school board for 20 years, and my mother had a degree in business. My dad served in a [dentak] in World War II, came back to practice and start a family, but found the housing crunch at that time prohibitive for moving out of New Richland, so he stayed – for 52 years. He was a general dentist, and was involved in every aspect of the community, as many dentists are. Our family believes that leadership is a moral and ethical responsibility. My brother David practiced in Wells and Albert Lea; John is based in Blooming Prairie, with five offices and 25-30,000 patients of record ranging from public programs to fee-for-service. One of my sisters, Beth, is a dental hygienist. My education is backgrounded in biology, chemistry, and psychology, starting at what was then Mankato State, now Minnesota State University. Then came the University of Minnesota School of Dentistry, class of ’83, after which I joined my father’s practice. He was always a stand-up dentist, but very progressive.
I was never cut out to be a city dweller, and always anticipated a rural practice. I love the people and the lifestyle that springs from these well educated, solid citizens. I bought my father’s practice fairly soon and started to bring it even more “forward”. I have always been a student, a studier, and I love change. I grabbed every good idea I could find, and within two years we had doubled the size of that practice. My dad loved that, and it added six to seven years to his practice life; he finally retired at 72.
With the advent of MNCare and its gatekeepers 17 years ago, I was recruited for the MDA’s Dental Practice (now Marketplace) Committee. As my understanding of that arena evolved, I decided to open a satellite practice in Waseca, where I quickly became so busy I was working all the time. I am something of an entrepreneur, and have started five other businesses over the years; I was also a medical commander in the National Guard, joining in 1981. Finally I kept my Waseca practice, where I am today with a staff of 12, and still very busy.
I thought at first that I would be a physician, but dentistry looked to have much more autonomy. My father and brothers agreed. Dentistry is still basically a “cottage industry”, with approximately 75% of us in small private practices. Our family and other dentists here actually have a following of hundreds of thousands of square miles in southern Minnesota. It was the best choice I ever made. We have virtual control over our destinies. The harder you want to work, the more people you can serve.
My wife was a pharmaceutical sales rep, and her background in business helped me when she came into the practice with me. Her perspective has been invaluable. Dentistry is driven much more by what patients want than by what they need. My job is to manage both for each patient. We are there to serve, yet the outcome is that the patients will take care of us! My father always said, “You do what’s best for that patient, and that patient and you will always have an outcome that will take care of you and your practice.”
NWD: Dentistry is a challenging field to begin with, but change now is not only constant, but often rapid and tumultuous. What grounds you so you can deal with all this?
Dr. Flor: Change motivates me. Lifelong learning is the utmost requirement in dentistry. You have to evolve; that’s a given. And you need the courage to face all the realities around you. I am a great advocate of dentists taking a role at every level in their communities, which are also constantly changing. Facilitating positive change is part of our core responsibility to our families, friends, patients, and communities. For new dentists today there is so much dentistry to do, to choose from, and to be responsible for that it demands much of their attention and intellect. It takes a couple of years in practice for the other factors to fill in and give them a complete picture of who they are and who they are becoming. The MDA is very focused on finding and nurturing young dentists at this critical point for all our sakes.
NWD: What gave you those tools, or gave you confidence in those tools?
Dr. Flor: I went to small business training at one of our technical colleges. I applied that. And I used consultants. I talked to all the dentists I could to find out their stories. You gain so much from that, and can put it to all kinds of use. I network to help people help each other. Business is personal, and that is, I think, the key to the success I’ve had.
I retired from the National Guard in November of 2001. We had evolved into a very effective medical/dental emergency treatment triage modality during my time of service, becoming a very mobile, light mechanized support unit that could be air-dropped into the field. I became a treatment platoon commander controlling the medicine, dentistry, and psychology areas. Evolving again, I was asked to be the first dentist company commander within the Red Bull division in 1991, around the time of Desert Shield. I had a top security clearance, was considered the brigade surgeon, did first-hands-on triage, finally becoming the state dental officer for many years. In peace and especially in wartime, 35% of non-combat incapacitating injuries are dental. In 21 years I think I did 250,000-300,000 dental exams. My father was a super-generalist, and taught us almost every aspect of dentistry. That would be my advice to students: Become a super-generalist.
I also was a founding director of Mankato State’s university foundation, worked in a number of their programs, as I did as an adjunct at the U. I have been on city councils, sports boards, private school boards — I find it fascinating. In 2002, I was asked to help the Open Door Health Care Center, a small and struggling volunteer group in Mankato. I reinvented their approach so they would operate as a business, pursuing grants, income, and growth. I took what remained of a large grant they already had and created a dental clinic in their existing facility, and Open Door became able to earn money to take it forward. We got the community to publicize the clinic, and went from 300 to 3,000 patients and an income of $15,000 to $280,000 in one year. Seed money and its attendant success inspire people to say, “What more can we do?” but first you have to demonstrate it can be done. Initial success has to be followed with sustainability. A lot of hard work produced more grants, and Open Door became solid and currently gained the status of a Federally Qualified Health Care facility (FQHC). It was at this time the MDA asked me to join the chairs (the officers ladder), I believe based on my experience as expressed through the work done at the Open Door.
NWD: The word sustainable is very central to you.
Dr. Flor: It’s absolute. Different points of view are great, but there has to be a way to be cohesive and use them. I try to be a consensus builder; I always listen. Each of us needs to be open to suggestion, clear thinking, to build consensus, and to recognize the strengths and weaknesses of the people around us. Team building, especially through education and personal development, making decisions based on understanding, and the willingness to keep looking for ways to do these things all come in service to the question, “Where do we seek the answers?”
NWD: At this point in your practice life how does this inform your choices?
Dr. Flor: I am the sum of all my experiences, and I can’t wait to see what’s next.
NWD: How did you begin in organized dentistry?
Dr. Flor: Then-president Bruce Bates called and asked me to join a committee. I didn’t know if I had what it takes, but he said I did, and that was all it took.
NWD: How did that bring you to the presidency? Did you have that “Who, Me??” moment?
Dr. Flor: I believe it was my experience with private practice MA, the underserved population, with non-profits and for-profit businesses, the FQAC concept, and colleges that put me on the officer track. When it came to being president, I never felt “singled out” for it, but I did wonder about the commitment. What I discovered was that even here there is opportunity for people to balance family and Association work. Everyone I have worked with brings something to the table; you don’t have to do anything alone. You do have to work smarter and be centered.
NWD: They say “There’s no such thing as ‘a job for life’ now”, but dentistry looks like the proverbial exception. What does this kind of commitment bring with it, both as benefit and responsibility?
Dr. Flor: Dentistry is something you can do as long as you can do it well, but all that is outside of it helps you discover what else you can do in your life. And I feel strongly that without outside involvement you cannot become a better dentist.
Within our professional realm, dentists now have a huge opportunity to shape patients’ behavior to their benefit, and to offer more ways to help than ever before. For instance, the lack of parental supervision currently has affected all historically stable aspects of our society, and dentistry is seeing more caries now than ever before. Yet even as other options for treatment have appeared and departed over the years, preventive dentistry has continued to evolve and has done more for the health care of the general population than any other single thing; that’s verifiable.
NWD: Once you were on the officers’ ladder, what did you have to learn that was outside your own practice or life experience, or at least your comfort zone? How did your personality fit, or not fit, the office?
Dr. Flor: Oh, I can be a madman in a group, but it was public speaking. The key is being prepared — have a purpose, set goals, then evaluate how you did.
NWD: What were the four years on the ladder like?
Dr. Flor: You start with what you bring to the table, but soon become aware of the resources that are available to you, especially from the talents of those you are joining. You need to support what has been built and respect its continuity. Within the group you may agree to disagree — I am not afraid of a diverse group of people — but their expertise needs to be cultivated. I observed and learned from my predecessors’ skilled relationship building, gifted communication, patience and thoughtful consideration of our work — all dynamics that create a consensus with which we can go forward. All it takes is a willingness to make positive change.
NWD: What are your own areas of special interest within the Association agenda?
Dr. Flor: My background automatically moves my focus to the mid-level practitioner. They can be workable team members, but they have to be under the close tutelage of a dentist, there has to be a free flow of information within the team, and they must overall become integrated within the office model. Any other scenario, I believe, will be unsuccessful because it will break down under various market and population influences as time goes on.
NWD: This Association’s issues, initiatives, activities, programs, and agenda are now at mid-point in your year. Give us a “you are here” report …
Dr. Flor: I would begin with our re-establishment of a better grassroots legislative advocacy program. We know the only way to better shape legislation is for every dentist in Minnesota to have a personal relationship with his or her legislators. We have Mike Zakula, Mike Flynn, and Mike Perpich in the chairs, and their expertise in legislation and policy is one of our strengths. The Association evolves to its purpose, in fact, through the presence of the right person at the right time.
There is as well the clarification of the advanced dental therapy legislation to be addressed.
Another initiative is our manpower issue. There is no dentist shortage; there is a demographic issue. That is the discussion. Our barriers-to-care language that was introduced here last year and is now adopted by the ADA defines the issue of access “in its parts”, the legislative piece being one of the biggest barriers, followed by the financial barrier. We are working to reframe the focus on this barrier to show that dentists are, always have been, and always will be willing to do what is necessary.
Another big issue is the requirement to move to electronic record-keeping. By the year 2014, dentistry is supposed to be part of a seamless electronic record system, controlled and stored by the federal government, yet we still have 40% of dental offices in this state working from paper charts. Even so, it is law that by 2014 every office should be able to import, report, and extract all information on any individual patient electronically. With the average age of the practicing dentist in Minnesota being 56 to 57 years old, and the urban core dentists most likely much more technologically based, where does that put the Greater Minnesota dentist manpower issue? That will be a tremendous barrier. With Greater Minnesota having a much higher percentage of uninsured, underinsured, and public program patients impacting this scenario, we have a big issue. We as an association need to work to help the older dentists even as we encourage younger dentists to work in outstate Minnesota. And we are indeed tackling the idea of outstate manpower.
Another coming issue for me is to care for all of our military veterans as they return. The federal government and the Veterans Administration are having great difficulty processing their dental needs. In Minnesota alone the number is upward of 25,000.
Finally, I want to make certain that we are utilizing our Strategic Plan that was adopted last fall to move the Association forward, and that all aspects of our Association are somehow tied to that Strategic Plan. We need to be nimble, dynamic, and to use that structure, and as we evolve reset our goals and aspirations.
NWD: What comes after the presidency for you?
Dr. Flor: [laughs] I already do the fishing, hunting, cross-country skiing, wboating — I’m going snowmobiling with my son tonight. (Sleep is overrated.) I love to travel. I will stay with the MDA in some capacity too: I won’t leave organized dentistry ever. I’m toying with the idea of starting a couple of new businesses, perhaps with my son and my daughter. I believe in using the gifts available to you to create other gifts.
NWD: In closing, what would you like to tell the MDA’s members?
Dr. Flor: I cannot say enough about the leadership of [MDA Executive Director] Dick Diercks, most especially his tremendous grasp of policy, legislation, and historical perspective. The MDA staff, this team, is here for a purpose, and all have continued to evolve. We will keep continuity with the past, but have a structured future that will keep our membership strong and vital.
That said, I want to emphasize that the Minnesota Dental Association would not be as successful as it is if it were not for its individual members. It is “an army of one”, and by that I mean it should operate from its greatest strength, those individuals. In the military, it was not the generals who were the strength of the army, it was that individual young person who could think outside the box and be an independent force. From squad level to platoon (district) to battalion (the MDA) to the army — the ADA is an army — each soldier has the strengths that can take him or her from the bottom to the top. There isn’t any general who wasn’t once a recruit. This association’s strength is that individual members join, then evolve each in his or her own way.
I think people need to hear that again, and hear that as you evolve you may indeed become that right person for the right time. There is, therefore, a responsibility and a duty in MDA membership that you do at some time actively participate. You will find that time and that level at which you will contribute. But there’s no such thing as “the perfect time” — so pick a place and start. Take a step, find out where you are, and go from there. It is our diverse backgrounds that in a consensus-building process allow us to come out with a oneness of thought and the confidence that together we can do what we need to do.